Dr. Claudine Courey is the founder of Eye Drop Shop, which has become one of the leading online retailers for eyecare products in Canada and the USA. She is also a clinical expert in specialty contact lens and dry eye.
In this episode, we discuss what has changed in Claudine’s professional and personal life in the past few years; how she balances family, clinic, and entrepreneurship; and some advanced clinical tips for fitting scleral lenses and treating complex dry eye cases.
This episode was supported by Thea Pharma Canada and recorded at their headquarters in Toronto. A big thank you to Thea for their continued support of the podcast.
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Doctor/Patient Psychology, Advanced Treatments For Neuropathic Pain, Entrepreneurial Success – Dr. Claudine Courey
My incredible guest is a returning guest. I’m so happy to have her back, optometrist extraordinaire, entrepreneur, mother, wife, all these amazing things. Dr. Claudine Courey, thank you so much for coming back on. I’m always so happy to chat with you.
Thank you for having me. It’s going to be fun. I look forward to these chats.
It’s always fun talking to Claudine. We are celebrating our one-year anniversary of doing the same show in the same spot, which I’m going to tell you about in a second. We did this same type of interview one year ago here. This is the fourth time Claudine has been on. If you haven’t tuned in to any of those previous interviews, please go back and check them out. We did one at Vision Expo East, that was our first one last year. The second one was in Quebec City. The third one was here in Toronto. Here is at the Théa Pharma Canada headquarters in Toronto. I want to give a huge shout-out. I can’t say enough nice things or enough thanks to Théa Pharma Canada for all their support.
Everything they’ve done for me for the show, for my clinic, for optometry in general, thank you so much, Théa, for everything. We’re here in the headquarters, and we have some of the team here. Everybody here at the headquarters has been amazing, even across to our reps in our office. Patty and Paula out on the West Coast in B.C., how much support they’ve given us. Especially, Paula, I want to give her a shout-out because a year or two ago, she was named Rep of the Year by the B.C. Doctors of Optometry. We’re not messing around here. Théa’s not messing around, that’s for sure. Let’s get to our interview.
Dr. Claudine Courey, it’s been a year since we spoke. We’ve talked about a bunch of different things over the last couple of years, like entrepreneurship. We talked about beauty trends, makeup, and stuff like that. We talked about dry eye, given that you are truly a dry eye expert, but you have so many things on the go. You’re speaking, you’re presenting, you’re setting up a booth, and we’re here for the Dry Eye Summit here in Toronto. You’re setting up a booth, you’re taking care of family, you’re doing all these things. It’s incredible. You’re running this business that’s booming. How do you do it? What does your day or average week look like for you? How do you break up all those things?
Balancing Professional And Personal Life With Team Support
It’s hard to hear it because then I realize what’s going on. The truth is it’s a lot of help. Anyone who says that they’re doing any of these things and assumes that it’s just me, it’s not the truth. Let’s be honest. There’s a huge amount of people who are working together to be able to make all these separate things happen. That’s the truth. It’s a great team effort. I’m very fortunate to have, in all those realms that you spoke about, great teams to support certain things. It’s give and take. Sometimes I come out here, and I got to do my thing. Other times, I’m the helper. I’m fortunate. Don’t you feel the same way?
Yes. I like that. I remember hearing the term servant leadership. You’re the leader, and sometimes you have to roll up your sleeves, and you have to take the position of letting someone else take the lead and you get to follow. Is that what you’re saying? You have to put people in a position to lead in a certain direction. Otherwise, if you’re trying to do all of it, it would be too much.
I’ve never heard that term. I don’t do it all is the real answer to that question. There are a lot of questions on balance, how do you balance it? I find that there’s no real balance, to be honest. You’re doing one thing well at a time. What I always say is you can’t do everything well at the same time. You got to have to pick. To be able to do those things, I have so many people that I rely on heavily.
I’ll get to that in a second, but there’s one person I want to give a shout-out to. He’s not here, sadly. That’s Anthony. Anthony, who is barred from now attending our show interviews. No, he’s just too busy. He has so many things going on. Poor Anthony, for one of our interviews, I think it was Quebec City. We’re recording, and he might have been behind the camera, but he was on there. He’s taking an important phone call. He’s running a business.
He’s working 24/7.
Claudine’s like, “Anthony, get out of here.”
I would not.
That’s how I remember it.
That’s not the truth.
It was something like that. Now Anthony’s never here for these show recordings.
He’s working. He’s setting up the aforementioned booth.
He’s such a good guy. I get it.
He is right. We work together as a team. Eye Drop Shop is a collaboration. He takes the lead on so many things. I’m very fortunate to be able to work alongside him.
That’s very kind. That’s very nice. That’s nice to hear. That was the first part of the question, how do you do it? You have a lot of help. That’s very nice of you to admit that and be humble about it. There are a lot of people out there who would like to say self-made. I don’t think that truly exists. What does the average week look like? I’m not the only person who’s wondering. You have a lot of people helping you, but you are in a lot of different places. How do you balance? How many days are you traveling in a given week or month? How do you split your day between when you work on Eye Drop Shop versus how many days are you in the clinic?
Mono-Tasking Vs. Multitasking
The truth is I’ve figured this out over the last little while. The root of all of this is that monotasking is the secret, not multitasking. You could do four things in an hour, half it, and then be on your phone and then answer the call, or you can devote an actual amount of time where you’re fully concentrated on that one thing, accomplish it, and then move on. It’s out of your head. I feel that’s the way I work.
You can devote a specific amount of time to fully concentrate on one thing, accomplish it, and then move on.
Here, I’m with you. We’re doing this. This is all I’m doing. I’m like 100% present. Afterward, I’ll be 100% present in the next thing. It’s these flowing things. That would be the answer, to be quite honest. If I’m not doing 600 things at once and all over the place. I’m here. Once I’m not here, I’m no longer here at all. I don’t think about it after. Although, I probably do.
I thought you think about these show interviews all the time. Never mind.
I do.
That’s awesome. That’s good advice, monotasking, blocking out time to focus on one thing. I’m guilty of multitasking. The funny thing is, even with my patients, I’ll be in the exam room, the patient sitting here, and I’ll be typing. The patient will ask me a question as I’m typing, and I’ll start answering it. I’ll stop. I’ll be like, “Just give me a second. I’m bad at multitasking. I’m going to finish typing this. I’m going to turn over.” Even in those micro settings.
They appreciate that “Hold on, give me two seconds. Let me get this off my brain, and then I’m right there with you.” They appreciate that more than a half-answer while you’re typing. That’s exactly a great description of what I mean.
It’s like you’re doing it on a bigger scale.
With patients too. Same thing. There’s the last-minute question as I’m charting my notes. I’m like, “Give me two seconds,” and I think it’s appreciated.
How many days are you in the clinic?
It varies, 3 or 4 days, depending on the week.
I wouldn’t have guessed. No offense.
None taken
You have an amazing amount of expertise. Not that I don’t think you practice clinically, but I would have thought it was less, given how everything goes. Is it potentially four days a week?
That’s my core. I love optometry. This is why I love doing this. I love speaking and everything to share and, in turn, learn from everybody else. The patient interaction is what I adore. That’s why I love going to the clinic, to figure out in each situation what’s going on in that person and trying to be a detective and figure out how to properly guide them and efficiently guide them. I love that. We could do ten different treatments, but my goal is how do I get them to feel better in the quickest shortest time?
Especially when you specialize, so to clarify again, Claudine does a lot of dry eye, but also a lot of specialty contact lens and scleral contact lens fitting. We’re going to touch a little bit on scleral and a little bit on certain aspects of dry eye. When you do get into this specialty care, I feel like there’s a lot of detective work. Even in primary care, there happens to be, why is this person not seeing quite as well as they should? Why are they getting this symptom? When you get more specialized, there’s a lot more of that detective work. You’re looking at a lot more different types of data points.
It is because you have a lot of extremely bright people who have seen this patient before you. There’s a bit of pressure in that sense because they are coming to see me after seeing a few different specialists. They’ve already noticed that all these people who saw them before were amazing. It’s like, “What can I bring to the table? How can I help them more than they’ve already been helped?”
That makes sense. We’re going to get a bit more into clinical conversation in a little bit. Staying on the overall work-life balance type of conversation, I know we were talking about this a little while ago. Maybe I should ask you, what’s changed from one year ago when we were sitting in this same spot and the conversation we were having then to now, November 1st, 2024. What has changed in your life or as far as your work-life balance since then?
Setting Boundaries To Improve Focus
Many things and nothing at the same time in the sense that I’m a huge learner. I always believe that when you know better, you do better. I adore learning new things. This is like asking me what my New Year’s resolution was. If we had to pinpoint the theme of the past year, maybe it’s putting a little bit more boundaries so that I can be present and do that mono-focusing thing. Maybe honing in on every decision that I have to make. Is this bringing me where we want to go either personally or as a collective team? If not, being okay with saying, “I’m going to sit that one out.” Maybe that would be it. Boundaries, maybe that might be the theme.
Setting boundaries has allowed you to mono-focus. Mono-task was a thing?
Focus on one thing.
Why don’t you coin it? You should TM that. You can start the query method by focusing on. Let’s see how well that goes. We can record another episode when that blows up. You can let me know. Setting boundaries is what’s been key to allowing you to focus more on one thing at a time. I feel like we were talking and you were saying that part of this is setting boundaries. Last year, when we were speaking, it was like, “I see patients, I come home, get the kids to bed. From this time until this time, I’m working on Eye Drop Shop.” Is that still the same or has that changed a little bit for you now, as far as working on Eye Drop Shop until midnight and then getting up the next day to go to the clinic, that kind of thing?
Prioritizing Rest And Avoiding Burnout
I prioritize sleep because it’s very important. There are waves. I tell my patients, “There are waves with dry eye.” Leading up to Dry Eye Summit, I knew that there was going to be a little bit more, but afterward, you can take these little moments to reset that won’t affect anyone else but will help you. Even if that’s on Monday, starting a little bit later and having a second to go workout, clear my mind, and reset, I think these little things that everyone talks about, we’re always like, “I think they’re important.” I do. They’re annoying, but they’re important.
Take those little moments to reset, which won’t affect anyone else but will really help you.
They’re so important. I love quotes and I love to say quotes, and there are probably so many I’m going to share as we go through this. Robin Sharma is one of the authors I love reading. I post this page. If people follow me on Instagram, sometimes you’ll see that I post a page and it’s a daily little paragraph of inspiration from it. One of the quotes is, “If you’re on a road trip and you never stop for gas, eventually, you’re going to have to stop. You don’t have a choice. Your car’s going to run out of gas. You have burnout or whatever it is.” Getting that rest, setting those boundaries, and taking those breaks is so important.
It’s not cool to overschedule and be like, “I’m dying.” I don’t find it’s a badge of honor to be burnt out.
It was for a while. We need to put an end to that now. There was a period of probably about ten years, maybe thanks to guys like Gary Vee, where it was like, “Work, work, work,” and there was nothing else. I feel like we’re getting to the end of that hustle culture kind of thing because we should be talking a little bit more about balance. Hard work is important.
As you mentioned the sleep thing, prioritizing sleep, I remembered one of the most famous people I’ve had on my podcast, other than you, secondary to you, was Hayley Wickenheiser. Ice hockey player. Women’s ice hockey legend. In her book and even on the show, when she came on, she said how important it was, something she learned partway or halfway into her career, like well into her career, she learned how important recovery was and how important sleep was. She wrote and said she thought of sleep as a weapon or recovery as a weapon. We need to think about it that way. If an elite athlete at the absolute pinnacle of a sport was saying that, we can probably learn from that a little bit too.
Talking To Patients About Foundational Health Habits
As ourselves. Also, the importance of counseling our patients about this, even though we feel like it might not be right. All these things that we talk about that seem maybe either not for us to talk about or seem like, “Sleep and drinking?” It matters.
That’s a very good point. I get a bit uncomfortable having that conversation with patients where it’s like, “Your eyes are always red, and they’re always uncomfortable. How’s your sleep?” “It’s not very good,” or, “I work night shifts all the time.” “How’s your diet?” “I don’t eat very well.” Some patients will be forthcoming with, “I’m drinking a fair amount,” or whatever it might be. These things all matter. You could put the eye drops in however many times you want, but if you don’t fix the foundational things. Many of us are not quite as comfortable as we should be having that conversation.
It’s okay. We have a certain amount of time with patients. I do talk about all these things, even though whatever they seem. They don’t seem like anything to me because I talk about them all the time. They’re very important. It goes with all the therapies we have. Counseling about this matters.
The Initial Shift To Specialty Contact Lenses
We’re going to talk about a very specific aspect or patient type as far as the dry eye goes, in a few minutes. Psychology and counseling and all of that are going to come into that conversation. Before we get into that, I’m going to change gears. We’re talking about work-life balance. We teased a little bit about scleral lenses and that kind of thing. Not that long ago, I was looking at my phone, which I have here. It was August 5th. The conversation started days before that, but I want to talk a little bit about scleral lenses.
We’re not going to dive too deep into it, but about a year ago, I made this mental shift that I wanted to do more specialty contact lenses. It was about a year and a half ago. It was around the time we first spoke in New York. I remember having that conversation with you and a couple of other people like, “I’m going to get into this.” It was first a big mindset shift. I didn’t even have a topographer or anything like that. I wanted to do Ortho-K as well. We bought a topographer. Finally, I was like, “I fit one scleral lens here, maybe one Ortho-K there.” I wasn’t picking it up. Earlier this year, I was starting to lean into it.
The interesting thing happens. You start mentioning it to more people and you start having more confidence about it. People start to take you up on it. Some of those people are your more traditional, maybe simpler fits. Some of them are a bit more complex. Dry eye, for example, they’ve seen 2 or 3 other people. They’re like, “Nobody’s offered me a solution to this.” You now mention something new, scleral lenses. “Maybe I’ll check this out.” I find myself treading in this new environment that I’ve never been in. I messaged you and you helped me out a lot.
You’re heavy into scleral lenses. Maybe for someone like me who’s new to it, what advice do you have generally as far as getting into scleral lenses? Do you have any advice for somebody who’s in the beginner stages of scleral lenses?
I know that it can seem daunting at the beginning. It does. If you are interested in it, your best resource is a rep of a scleral lens company. There are tons of CE you can take to get the first step. It’s great to know someone who does it. I could be that person, but it is great. I did my residency, so I had that backing. If I didn’t, I would have loved it. Phone a friend or someone you could text in the moment. Ultimately, it can be simplified. You can start with relatively regular corneas for dry eyes. That’s a great way to start because it’s a regular cornea. It’s a bit of a less tricky time to fit.
Scleral Lenses For Dry Eye Treatment
Very interesting. Let’s talk about that for a second. I’ve heard about people. I think we touched on this last time we spoke too, but let’s give some advice to somebody out there who’s tuning in and who might be interested in this. I’ve heard about some doctors using scleral lenses for dry eye. How does that work? What is the mechanism of action there to help with the dry eye?
That’s how I got into dry eye. It’s through this. I was in scleral first. That’s how I did my residency in that. My friend was like, “Do you want to come fit scleral for dry eye?” That’s how I got into it. Essentially, if we boil it down to the bare bones, if someone’s putting in drops multiple times a day or if they have a ton of SPK, you’re filling the reservoir of the lens with a drop or a gel drop, I like a gel drop a little bit better. It’s sitting on the eye all day. The eye is swimming in this drop and healing the front surface of the eye. That’s the 101 of how it works.
Got it. Any specific gel drop or drop in general that you find is beneficial?
Genuinely, I use the Thealoz Duo Gel. We’re here now. What a surprise.
I’m kidding. I already knew the answer. I want to use that. That’s a genuine answer. That’s not just because we’re here. I know that’s a genuine answer. It is because Connie and I had this text message conversation, and I have this open on my phone. I was telling this story earlier. I had a more not simple, not easy in the sense of the patient expectations, not an easy fit, as far as the corneal shape and all of that is not that bad. This patient was best corrected at 20/25 minus. I’m going to read the text messages out to you a little bit.
I called Claudine. We spoke on the phone. I was like, “Claudine, I have this person coming in for their first fitting, assessment, diagnostic, or evaluation of the lens so I can order the right lens for them, but I’m not very comfortable fitting scleral.” Claudine coached me through it. She sent me this text message with “Claudine’s Ten Steps to Fitting a Scleral Lens.” It’s amazing because I followed these steps. They were great. I’m going to read them out unless there’s one you don’t want me to read.
I’ll read them quickly. I’ll give a short version of it. Step one, consent form, set expectations. Step two, check the cornea. Step three, select the lens. Step four, put a few drops of a viscous drop. In this particular case, Claudine recommended the Thealoz Duo Gel. Number five, check the eye and make sure there are no bubbles. Step six, have the patient wait for fifteen minutes. Step seven, do autorefractor. Eight, refract the patient. Step nine, recheck the cornea, do the fluorescein stuff, the pattern, because I don’t have an OCT. Step ten, remove the lens, order the lens, and do the calculations. Step eleven is very important, text Claudine along the way, smiley face. Step eleven was important because I did.
There are a couple of key things in here. Number one, using the Thealoz Duo Gel made the whole thing so much easier. In this case, we weren’t specifically treating dry eye, but I put the Thealoz Duo Gel in it. The lens went right on the eye, no bubbles, no nothing. It was so much easier for the patient. The second thing is nobody ever told me to do autorefractor. There are some people out there judging me for doing autorefractor, but I did it, and it was so much easier than the 3 or 4 people I fit before. I texted you two days later. “Update, did the fit. Thealoz Gel and autorefractor were a huge help. We were able to improve the VA from 20/25 minus best corrected to 20/20 minus for each eye.” That’s a whole-line improvement. From 20/25 to 20/20, it’s not just one line. That’s a pretty significant change.
I would say also that this is one of the hardest cases to fit in because you’re not getting that big wow effect. You’re not taking someone who, for example, has a cone and cannot see or sees very blurry to 20/20 and get the wow. These are tricky and you nailed it.
Thanks to you. That’s why I wanted to share that. Even though it was a one-line change, she noticed a significant change. She was like, “I know for a fact because we’ve been through this for a while. I’ve tried everything else up until this point to try to help her see more clearly.” She’s like, “I know for a fact I couldn’t read that line before.” She was quite happy. We’ve ordered her lenses, and we’re going to get her back in soon and check her vision but like that. The process of fitting, adding the gel, and doing the autorefractor was a huge help.
I wanted to touch on that because I thought that was so helpful. I know for a fact that there’s at least one person out there who’s like me, who’s like, “I’ve never used a gel before. I’ve never done autorefractor before.” Something out there. I wanted to touch on that. We’re going to talk a little bit more about scleral later. We’re going to shift gears. There’s something that you’re doing that’s unique with the scleral that we’re going to talk about. We’re going to shift gears more to dry eye, your other specialty.
I won’t say I’ve exhausted the topic of dry eye, but we’ve had a lot of guests who’ve talked about dry eye over the last few years. It’s been a hot topic for a while. I do a fair amount of dry eye treatments in my office, not to the same level that you do, but I know that our audience has probably heard a lot of episodes of dry eye. We’re going to talk about a very specific type of patient. We’re going to talk about patients who come in with neuropathic pain.
The first thing I’d like you to do is, because I know these can be very challenging patients, whether our colleagues out there have a patient in their chair that they’ve defined as having neuropathic pain, or maybe when we go through the definition and the description of it, they’ll say, “That’s what the problem was with that patient.” It is because we’ve all had this type of patient in our chair, for sure. Why don’t we go through, if you can define it for us, what is neuropathic pain? Why does it arise? What can be the causes of it?
Understanding Neuropathic Pain
Neuropathic pain is essentially perceiving pain in the eye with a non-painful stimulus. It’s a diagnosis of exclusion. Most commonly, what I hear is these patients will say they’re very sensitive to light, almost that the light coming off of their computer screen is too much, or they’re wearing sunglasses inside. Not like, “I go outside and it hurts, so I put sunglasses on.” It’s an oversensitivity to light.
Another one is an oversensitivity to wind. You know those patients who say, “It hurts. I can’t tolerate going outside.” Sometimes, they wear swimming goggles outdoors because they cannot tolerate any little gust of wind. These patients are in excruciating pain. There’s a spectrum, but usually, they’re in a lot of pain. When we look at the eye, we see absolutely nothing. Your classic pain without stain is the definition of these patients.
Pain without stain. That’s the key phrase we’ve all heard or many of us have. The patient’s super symptomatic, sensitive, uncomfortable, but when we look at the eye, we put fluorescein on, or whatever we’re doing, there’s hardly anything there. What causes it?
There’s a slew. When we talk about it, the number one thing that’ll come to mind is probably post-op, like LASIK or something like that. Unfortunately, there have been so many horrific cases of this. In the news, there are entire Facebook groups devoted to this, and rightfully so because support is important when you’re suffering. That’s what comes to mind, but on the ocular side, there are so many other things. Even chronic dry eye can lead to this.
There are so many other causes and it could also be systemic. Patients who are prone to migraines, patients who have fibromyalgia, and anything else can flow together. We know that the cornea is the most sensitive place or one of the most sensitive places on the body. It’s almost 300 to 400 times more sensitive than the skin. If the patient is already extremely sensitive to touch like this, imagine the pain they’re going through in their eye. I’m passionate about this because I see so many now. I’ve seen 1 or 2, and I think I’ve been referred to a few in the area. Over the past year, I’ve had a huge influx of neuropathic pain patients and have had to find solutions for them. The truth is it ends nicely, this story.
This one has a nice ending, but there are a lot of times where I, and again, I assume there are others out there who are like this too, but we try everything. We try the drops. We try the steroid drops. We try the other anti-inflammatories that we have, and the other pharmaceutical agents that we have available to us. We try all these different things, warm compresses, ointments, and everything else. That patient never seems to feel better. Maybe slightly better, but not a whole lot better.
Psychology Of Treating Neuropathic Pain
We do the treatments in the office, RF and IPL, and all these things. There’s limited improvement, and it can become frustrating for everybody. I know you are passionate about this side of the conversation as well, which is the psychology of it. We’re going to talk about the treatment of it, the medical treatment, but the psychology of it is so important.
This goes with a lot of dry eye patients in general. In a case like yours, and for me, even to a lesser degree, but because we have certain technology and we offer certain treatments, we are getting referrals from other doctors or patients who will find us after they’ve seen a couple of other people before. You tend to get some of the more complex patients, and they usually come in pretty upset. I was wondering if we could talk a little bit about psychology from both angles. Let’s talk first maybe from the patient’s perspective. What is generally the patient’s psychology when they have this type of issue?
The number one thing is to sit down and take the time to completely listen to the patient’s history. By doing that, we even go back a few steps, and it’ll flag us to screen for corneal neuropathic pain. It is because it’s on us to pick up on these little things. For example, any history of eye surgeries. If they’re saying that they’re hypersensitive to these things, if they have any physical systemic conditions that are also chronic pain-related, at least we think, “Let me do that.” To screen, we could go into it maybe a little bit, but I have a few little tests that I’ll do over and above our regular dry eye screening. There’s the Ocular Pain Assessment Survey, OPAS. It’s essentially like an OSDI for pain. Specifically ocular pain, which is great. I’ll bring that out and also the Alkane test.
The Alkane test is if there’s nothing on the cornea and everything looks fine, you’ll ask the patient, “On a scale from 1 to 10, how are you feeling at the moment?” Let’s say they say 8 out of 10 in pain. You put a drop of Alkane, wait a little bit, and then see how they feel after. Depending on what happens, you’re going to know if the pain is peripheral or has hit the central nervous system. If the patient says, “It’s gone down to 3,” we know that what we can do in the office, helping them with their eyes, will have an impact. It’s a very positive conversation. We’ll be able to say it’s more related to peripheral pain.
If it doesn’t change, which hasn’t happened to me yet, there’s always been a bit of an improvement, then the pain has become centralized in the central nervous system, meaning the brain and spinal cord. That’s a bit trickier and needs other specialists, such as a pain management clinic, a neurologist, or a psychiatrist for more advanced testing. In our office, you could also measure corneal sensitivity. Either with something fancy like a Brill or Cochet-Bonnet, or you could remember from school, it’s like this pen, Cochet-Bonnet. I don’t know what you call it. It looks like a pen. At the end of the pen, you roll it, and there’s a string.
Are there any other French speakers?
No, but why do I speak French? Anyway, I’m fine. It’s like a little thing that comes out, and essentially, you put it on the cornea, and then it’ll measure the sensitivity of the cornea to the stimulus. The shorter the thing is, the harder you’re pressing.
I poke people in the eye. Is that equivalent?
Poking’s fine. You heard it here first.
The 20/20 Podcast, always giving the best advice.
These are things that you could add. Once we’ve figured out if there’s a neuropathic component, then we could take a different route. Also, sorry, that was the longest answer to validate the patient’s feelings and emotions, what they’re feeling, and what they’re going through. That’s step number one because they have usually been bouncing around. I understand because they look fine, or you’ve even tried IPL, LLT, RF, and everything, and they’re not feeling much better. Again, that’s fine because we have to treat the baseline dry eye first. That’s all good that we did that, but if they still have symptoms, we shouldn’t say, “It’s done.” There are other things that we could do.
Step one, validate the patient’s feelings and symptoms. Acknowledge. Step two, Cochet-Bonnet?
No, but that thing is great.
Patient Psychology And Empathy
I’m joking. Step one is patient psychology. They’re coming in, they’re feeling a certain way. Many dry eye patients are quite upset. I have had the experience with a few patients who have told me about how seriously it affects their feelings, depression, and other things that come with that. I’m sure many of us have heard that, but I want to flip that. Let’s look at it from the other angle.
What’s the doctor’s psychology on this? You’re looking at this patient. How should we frame this patient and how they’re talking to us? It’s easy for us to get a bit defensive when a person comes in and starts asking us a lot of questions or saying, “I’ve been to this clinic before. How are you going to help me?”
I hear you. On the other side of the slit lamp, we’re also people. We also feel perhaps, “I’m here exclusively to help. This is my role. I’m here only to do good.” If someone comes off as abrasive, it’s hard to have that kind of interaction. The secret to all of this is recognizing that the patient’s behavior is a forward-facing expression of their underlying emotion.
A patient who, for example, is abrasive or questions a lot, maybe they’ve had previous experiences where they didn’t feel heard. Maybe they’re scared and thinking, “Am I going to live like this my whole life? I can’t keep functioning.” Maybe they’re speaking so much because they want to make sure to get everything in, so they feel like, “I want her to know everything she could know so she can help me best.” Maybe they’re scared, anxious, sad, or frustrated.
Ask the doctor to be able to see past any kind of emotional behavior that they’re facing because it’s not about you. The patient just met you. If they just come in, you know that. My patients who come in the most unsettled, I know they require the most help and have tried so many things. I’m so empathetic towards them. I understand because if you feel any kind of pain, even if you get a paper cut, all you do is walk around, go to work, and do everything, but it’s that gnawing pain in the back of your head. It’s a little thing, but this is not a little thing. This is taking up their whole life.
This is what they’re seeing through. They’re not able to complete daily tasks. Their quality of life is altered, and they’ll come in and say, “I’m a 57-year-old businessman. I’ve been functioning completely fine my whole life, and then this happened. I did this surgery, and look at me.” I’m not saying it’s the surgery. I’m just saying.” No kidding he’s frustrated. I genuinely don’t blame them for feeling this way because it flips their life upside down. If we could flip it back up, it would be an amazing reaction. It’s incredible.
Empathy is the key to all of that.
Understanding that what they’re saying is real, that they’re living through something extremely challenging, and that we’re there to support them, and we have tools to help them. Not taking it personally. I don’t take it personally. I know it’s not about me, at the beginning or the end.
Not at the beginning, maybe at the end. That’s super helpful. Seeing that through that lens, understanding that patient is coming in, they’re probably extremely frustrated. They’ve probably seen multiple doctors before. When they’re expressing their frustration, it’s not at you. It’s to you. They want to be heard, and helping them feel heard. I found the most rewarding is the patients who seem the most happy are the ones who simply feel heard. I’ve taken a few extra minutes, maybe they’ve even cried. They’ve been able to go through all their emotions and feel like they got it all out.
Often, in some cases, I don’t think I’ve done anything more to treat. I may have done the same thing, but given them a maybe more clear plan of some of the same stuff they’ve done before, and they feel so grateful for it. Again, that was more about discussing the psychology of it, and how to approach that conversation. What about actual treatment? I know something is exciting that you’re doing that helps these neuropathic pain patients. I would love for you to tell me.
In the beginning, we treat dry eye disease. That’s the first step, make sure that that takes away how much of the percentage of the irritation or symptoms. Following that, we’ve got a PRGF setup in our clinic. That’s plasma rich in growth factors. Essentially, the nurse will draw the patient’s blood, centrifuge it, and put it through a bunch of steps. At the end of this, the patient has little vials of their growth factors, let’s call it, or that’s how I’ll explain it to patients.
I’m like, “Hear me out because this is going to sound like something else.” Also, they take your blood, and they spin it, and they get part of your blood that’s super rich in growth factors from your own body and make eye drops out of this. What this does is you put the eye drops, and it helps regenerate those nerves that are firing to your brain that there’s pain when in reality, there’s no pain. Most of the time, they’re like, “I heard about that. My cousin got injected in his knee. They used it for hair.” It’s not as weird. I made the setup pretty big because it is a bit funny to think like, “We’re going to make drops out of your own blood.” These have worked wonders. They’ve been great.
It’s funny you say that. I’ve mentioned it to a bunch of patients. I’ll tell them, here’s how much we can do for you. It’s not the end of the road, but this is what we’re capable of doing in our office. Beyond that, patients will say, “What else is there?” I’ll mention this PRGF or PRP. Most of them have heard of it, from skincare, from hair, from whatever. There are all these different places that they’ve heard of.
They haven’t heard of it for eyes, but they are fairly familiar with what it is to begin with. A similar conversation with IPL, for example, a lot of people have heard of IPL. A lot of ladies, in particular, have heard of IPL and maybe even RF. They’re like, “It’s interesting you can do that for your eyes.” The same goes for this type of eye drop. You take PRGF, and how does that work? Let’s say, centrifuges are put into the little vials. What’s the dosing schedule?
Typically, it’s 3 to 4 times a day. The series goes on for three months. They get three months’ supply. I’ll call them halfway through and then see them at the end. It’s done well for these patients who have been able to feel a lot better. I’ve had genuine amazing stories. I think of patients at the beginning and then how they are at the end with this. It’s an added thing. We’re happy to have that now in the clinic and be able to offer it. Patients are also very appreciative to have a solution that they feel is also holistic or natural, if you can call it that. I don’t know the right term, but essentially, they feel good knowing that it’s their own body that’s repairing their own body, which I love also. That’s great.
Patients are very appreciative to have a solution that they feel is kind of holistic. They feel good knowing that it’s their own body that’s repairing itself.
There’s a big, I won’t say movement, but patients do appreciate that. Even when you make simple, holistic recommendations like warm compress and omega-3 and stuff like that, they’re like, “That’s natural. I like that. I’m supporting my body producing its own, whatever it needs to produce.” This is taking it to a different level. What’s the next step with PRGF, if we were going to make it more exciting and different? There’s one more thing I want you to talk about.
Scleral Lenses And PRGF For Dry Eye Treatment
Let’s say, those patients I spoke about earlier that are complaining of wind or a physical stimulus. They can’t go outside, the AC and environmental factors bother them a lot. This is why I’ve been in scleral lenses because they act as a barrier. It’ll help in those cases. We’ll fill it up with the LASDO, which I could also explain is going to help work on helping the health of the cornea. In my cool cases, I’ll put the PRGF within a few drops within the scleral lens. We have the bandage, we have the drops that are helping to regenerate the cornea and the corneal nerves. It’s been wonderful.
Within the lens, you’ll have the Thealoz Duo or Thealoz Duo gel plus the PRGF, and a few drops. It is because you’re only one drop 3 or 4 times a day. You don’t want to bathe the cornea in the PRGF.
With that, it’s also depending. It could be not exactly to see through it. We want to make sure. It depends on the patient and all that kind of stuff. Essentially, we want to keep it and it’s still doing its job.
Does the patient do that themselves at home? When they put the lens in in the morning, so you’ve trained them how to put the lens in. This might be a person you alluded to earlier, basically a spherical cornea. They don’t have any corneal issues.
That would be great. We do it in all different cases, but if it’s a regular cornea, it’s simpler even to do that fit.
You teach them how to get the lens in and out. You send them home with it and you say, “Fill it with Thealoz Duo and three drops of your own blood, and then put that on your eye.”
Let’s say the person would have already had to do a round of PRGF, or they’re already scleral, I won’t start both at the same time because I find it’s a lot, but typically, this has been great.
You’re doing the PRGF on your own, and you’re seeing some progress, but they’re still sensitive. Maybe not as much progress as the next level.
I’ll repeat another round of three months before going to scleral, but all to say, these are all in our tool bag, and patients who weren’t able to function before are completely functional members of society. Most importantly, they’re able to go back. I always ask them, I still do the same thing, but I’ll say like, what is your personal goal, and then we loop back on that.
Personalizing Treatment Goals
That’s something you told me last time. I find that so huge. I started to integrate that to some degree, not as often as I should, but can you tell me about that again? We talked about this, not neuropathic pain patients, but dry eye patients in general. Sometimes, you’ve been doing treatments for three months, six months, a year. It’s hard for the patient to say how much different they feel. I’m going to go back to my original and be like, “Here’s what your complaint was. Do you still feel this? Are you able to read these many minutes? Are you able to look at your phone for this long?” You have a different approach, which I thought was cool.
We do everything and I have all those measurements, but I’ll look at the patient and say, “What is your dry eye preventing you from doing now that you wish you could do?” That’s my line. My patients know it if they ever see this. That’s my go-to line because that is what personalizes an exam. Whatever it is for one person, it’s rarely the same for another. What is important to you? That’s what I care about. I care that you are going back to your regular life. I care that my patients are no longer thinking about their eyes. That is the goal. We shouldn’t be feeling our eyes. We should be going about our life and doing what we have to do and our eyes shouldn’t be felt. If it is, then it’s an added layer in everybody’s already busy life. We want to remove that.
I love that. You set that goal. That helps in a few ways. One is when you go back, you can say, “Are you able to read these many pages now or whatever your goal was?” Hopefully,y they say yes, but also it helps you tailor the treatment and have a target to shoot at. I now know how I need to angle my treatment to get this result. Otherwise, we’re a little more broad, I just want them to feel better, but that’s hard to gauge.
I’ll see them and have the reading. They’re like, “I did 2 or 3 pages, but I wish I could.” “We’re almost there,” but it’s so personal to every single patient. That’s also appreciated because it’s going towards whatever they need in their life. That’s the point too. I don’t want to see all these metrics get better on my end. I do but I want them to say like, “Oh my God.” When I hear like, “I can finally do this thing,” it’s the best feeling. This is why we do what we do.
I love that. I didn’t want to spend too much time on the dry eye because I know we’ve covered this so many different times, but this specific topic of neuropathic pain may be one of the more complex or challenging topics for us in the exam room. We haven’t covered it a whole lot on the show. Thank you very much for giving your insight on that. I want to change gears again. The 20/20 Podcast is about entrepreneurship and personal development, business development, and that conversation. I don’t do a ton of clinical conversation. We got to talk about the more entrepreneurial side of things. Eye Drop Shop is your baby. When did you start it?
It’s six years old, this baby.
Entrepreneurship And The Early Days of iDrop Shop
Let’s do this as quickly as we can because I know we have covered it. If you go back and tune in to our first interview from March of 2023, that was when we dove deep into Claudine’s journey in entrepreneurship and how she started Eye Drop Shop and went from there. Give us a super quick version of it. The TLDR. How did it start? What was Eye Drop Shop like in the very beginning? What was your role? What were you doing? What is it now?
I was doing everything in the very beginning, every single thing. I was packing the box and dropping it off and doing the whole nine yards, which is everybody’s story as a beginning business and also has served me so well in our growing the business because every step of the way, I know what’s required and not to be able to say, I could do every step, but also to know what is a fair amount to anticipate from a person to produce. That’s very good to be able to gauge.
We’re now a nice little team and we’re having fun. What hasn’t changed, this is not a tacky saying at all, but the whole point of it has remained the same the whole time and will continue to remain the same. That is to help people have access to high-quality products that they normally couldn’t. We’ve also branched out into wholesale. We now work with optometrists. We always do. The clean beauty section has been fun. We opened in the U.S. We did that three years ago. That’s it. We’re always thinking and innovating and thinking ahead. It’s so much fun. I adore this part of entrepreneurship. It’s a ride.
That’s excellent. I have a quote in my mind again that I want to share. It’s an offshoot. It’s not exactly in line with what you’re saying, but I feel like it’s relevant. To tee it up, you talked about the boxing and the shipping and all these things. You did all of that stuff. Sometimes that whole process can get stressful and tedious. It’s so important to learn from those things. As you said, when you get to this point, you know how to do those things. You know what it takes to do those things right. Sometimes we want to get to a certain endpoint and not want to do those things, but there’s a lot of value in doing those things.
There’s a quote. I know I’m taking a bit of a tangent, but I think it’s relevant. I wanted to share this. I thought it was a good quote. To that point of enjoying the process, even as a parent, as a business owner, or as a doctor, we all have our goals. We’re all trying to reach a certain target or, specific to this analogy, we’re all trying to climb a certain mountain. Sometimes we forget to enjoy the process and those tedious things and whatever your routine might be with your kids. Sometimes you forget to enjoy those things because there’s so much value in all of those things.
We all have our goals and are trying to reach a certain target or climb a specific mountain. But sometimes we forget to enjoy the process.
The quote is, “The only wisdom you’ll find at the top of a mountain is the wisdom that you brought with you.” I think the word wisdom can be interchangeable with peace. It could be a success. It could be fulfillment. The only fulfillment or satisfaction you find at the top of the mountain is the one that you brought with you, not brought with you from the bottom, but what you gained along the way. It’s something I wanted to mention too. I think you can vouch for this too, but to all of our friends out there who are working hard, don’t forget to enjoy the process.
Don’t forget to learn along the way. That way, when you do get to the top, you have something to enjoy. You can enjoy that view properly. That’s where I think you are now. I would say you’re at the top of one of those peaks. Tell me about that. At the top of this peak, there is a certain achievement that I wanted to congratulate you on that you have achieved. We were at Dry Eye Summit five years ago. When did you start Eye Drop Shop again?
Six years ago.
When did you start getting involved a little bit with the Dry Eye Summit?
Growth And Success of iDrop Shop At Dry Eye Summit
A few years ago, I heard the Dry Eye Summit was around, and then it was a big conference and stuff like that. I wanted to attend, but it might have been COVID-ish, like 2020 at that point or the year before. I always thought that would be cool. We attended our first show three years ago. This is our third year this year. We did 2022, 2023, and now 2024.
When was the first time you set up a booth?
In 2022.
2024 is a different level. Tell me.
We’re the presenting sponsor with three other presenting sponsors. It’s a nice little moment of working hard and getting to be able to give back in a certain way. We have a lot of things planned for this weekend. It’s nice to be able to work with other great companies.
Like Théa Pharma Canada?
Correct.
When we were talking on the phone, this one thing I wrote down, it meant a lot to me as a friend, you’re such a good friend, and I love to see you succeed. You said five years ago, we couldn’t even afford to have a booth.
That’s true. It is because I remember talking on the phone with Trevor. He’s like, you could come to Dry Eye Summit. It’s X amount. I was like, “Trevor, this is like I miss startup. We can’t.” It’s nice to see that.
That Trevor is always funny. I’m kidding. Trevor is a great guy.
I will stand up for him any day. I was telling him, “I’m sorry, but hopefully one day.” That’s it. It’s nice to finally get to the point where now we could be here in a big way, contribute to the dry eye field, contribute to education, contribute to all the things that mean a lot to me personally, and then Eye Drop Shop.
It’s amazing to see how much it’s grown. That one sentence or that one quote alone stuck with me when we were speaking and speaking on the phone a few weeks back. Five years ago, you couldn’t even afford to have a booth. Three years ago, you were able to afford to have a booth. Three short years later, you’re the presenting sponsor of one of the most well-renowned dry eye conferences in North America. It’s amazing.
My favorite one.
Mine, too. It’s great. I want to talk about Dr. Ashley Brissette. This is something you told me about, something else that’s exciting for you. Tell me, who is Dr. Ashley Brissette for those who don’t know her?
She’s a world-renowned ophthalmologist. She’s from Toronto. She’s in New York. She did her studies at McGill and then now she’s at Cornell.
You’re both McGill buddies.
She’s amazing. Wait till you meet her. She’s fantastic on all fronts. She’s such an incredible clinician. She works at Cornell as an ophthalmologist. We’ve known each other for a while. She’s now come out with her own clean beauty line. We’ll be exclusively distributing it through Eye Drop Shop. She’s coming. She’s going to present. It’s a privilege to have her here. That’s another fun part, to be able to make these connections and meet such incredible people. Learn from her as well. Overall, I love this part. It’s so much fun.
That’s amazing. That’s very cool. I do look forward to meeting her. Very cool. We’re going to wrap up very soon. I have one other final question for you on the topic of what’s exciting about Dr. Ashley Brissette and her line. What other products are exciting for you in the Eye Drop Shop or clinic?
There’s a lot of new stuff. We brought it all. It’ll all be at the booth. Essentially, we have a lot of new stuff. There’s new all makeup stuff.
I feel like that’s a big move. Understandably. I get to bring samples of stuff back for my wife. I’m like, “Can you try this now? Can you try this?” There’s some stuff more that I brought, Blephsol Duo. Going back to our amazing rep Paula, she’s like, “You have to get your wife to try this.” I’m like, “Cool.” I was like, “Pam, next time you wear makeup, you’re going out or whatever, try this out. Tell me how it is.”
She was pretty amazed by how well it removed her makeup. I was like, “Use this as your primary makeup remover, and let me know how it goes. Don’t wash your face or anything. Tell me how it is.” She was quite amazed. The first time she used it, we were out for a Halloween party. She was wearing a fair amount of makeup. She did some whatever cat makeup or whatever she did, but she used it again. She was pretty impressed.
That’s new. There are so many new things that are now out on the market. We’re excited to share all of that.
Go to EyeDropShop.com.
It is .com in the US and .ca in Canada. If you’re an optometrist, there’s a wholesale section to be able to access all this fun stuff. We’re constantly looking for new things. It’s fun.
Eye Drop Shop. Make sure you check it out. The last time you were on was a year ago. For a long time, I had these two questions. First of all, before I get to those, how can people find you? We did Eye Drop Shop, how can people find you if they want to connect with you directly?
They could find me on Instagram, which I think is a good one. At @EyeDropShop or [email protected] is easy. They’ll redirect it to me.
On TikTok, you’re like a TikTok superstar.
We’re not talking about TikTok.
It’s @EyeDropShop on TikTok?
It is.
Superstar. How many have come on? Is it 20,000, 30,000, 40,000, 50,000? Where are we at?
63,000. Who am I?
The Role Of Social Media In Business Growth
It’s amazing. Any optometrist who’s looking to build their online presence, let’s say on TikTok, for example, go look at Claudine’s stuff. I would recommend scrolling back because you’ve figured out a way to the type of content you post. It’s good, it’s educational. There’s not a lot of singing-dancy stuff. It’s like educational content. You’ve figured out a simple way to present it where people are engaging a lot with it.
The point of this whole thing was that it stemmed from guilt. If you want to know the truth, because my patients at the end of an IPL or at the end of all these treatments would be like, “I wish I knew this before. I’ve been suffering for so long.” I feel bad holding all this info in. That’s why I think if any optometrist has the desire to share their knowledge in this way, we’re able to help people.
At least my mission is to help people go to their eye doctor and have a proper evaluation instead of picking up whatever they can from the pharmacy and self-treating themselves. I’ll always explain something. If there are questions, I’ll say, “Go see your eye doctor. They’ll be able to assess you personally.” It’s been great because it has helped people. I laugh because I’m super silly on there.
It’s great but that’s that platform. For those of our colleagues out there who TikTok. I tell this story in lectures that I give these lectures that are building your digital presence or e-commerce, that kind of deal. Driving people into your office using social media platforms. I tell this very true story of when I took one of my daughters to the doctor and we went to the doctor’s office. It was empty. One lady was sitting a few seats down from us. We were waiting to go in to see the doctor.
A young girl, probably a teenager, 13 or 14 years old, comes out of the doctor’s office and goes straight to her mom. She says, “The doctor said I have TMJ.” Not quietly, I’m telling you what I heard very clearly. The mom looks at her puzzled. She goes, “It’s OK. I already looked it up on TikTok.” In that period of time between when the doctor told her to when she came out to talk to her mom, she looked it up on TikTok.
If you hashtag medical on TikTok, there are over 20 billion views of hashtag medical on TikTok. A lot of people are going out there to find this information. We may as well be the ones to provide it. Not some teenage girl who’s trying to teach you how to put contacts in. There’s a girl on YouTube who’s got like a million views on her video of like her. Why is a teenager doing it? It should be professional. This is my point. It’s great that you’re doing it. Look for Claudine on TikTok. Previously, you know that I would ask the same two questions for a long time. I’m not going to ask you those two this time, but for those who are newer to the show, I would always ask: if we were to go back in a time machine, did you answer this?
I did.
If we could go back in a time machine to something difficult, what advice would you give to yourself? The second question was, how much of what you’ve achieved is luck versus hard work? Do you want to answer one?
No.
Cool. The new segment that I’m pushing is called You’re Welcome. You have kids. Have you seen Moana, the Disney movie?
Yeah, of course.
The character Maui has a song, You’re Welcome. The point of the song is for those who are uninitiated he’s very egotistical, and he’s like, “I’ve done all these nice things for you. You’re welcome.” The point of this segment is for you to give us one profound piece of advice or one amazing quote that is impactful. You’re going to share that, I’m going to say thank you, and then you’re going to say, “You’re welcome.” Think about it. Let’s do “You’re Welcome.”
I have one. This is a good one. This is a great one. Listen to understand, not to reply.
I like that.
That helps in all facets of life, but especially in patient care, with exactly what we’ve been talking about this whole time. Listen to understand, to absorb what your patient is saying, not to come out with what you want to say further. With that, your patient or the human being you’re speaking to will see that you’re there and you care. Once the trust is there, the treatment will go so much better.
Amazing. Listen to understand, not to reply. Thank you so much.
You’re welcome. I can wrap the whole thing up.
Claudine, thank you so much.
Thank you. Thanks for having me.
I can’t wait till we do another one of these. The funny thing is, before we set this up, a big thanks to Mike Berg for encouraging us to have this call and this talk. I called Claudine like, “We should do this again. It’ll be amazing to hear back at the one-year anniversary conversation.” Claudine’s like, “What are we going to talk about? Aren’t people sick of me by now?” I’m like, “Are you crazy?”
I felt like they heard me three times.
Look at how much we talked about. It took us almost 45 or 50 minutes.
I love coming here.
It’s practically a new conversation.
It is. It’s always fun.
If anybody’s sick of hearing from Claudine, make sure you text me. Message me on Instagram at @HarbirSian.od. If you never want to see Claudine on the show again, please message me. I’m kidding. If you love this conversation, make sure you share it. Please make sure you message me. Put a screenshot on Instagram and tag us both. Let us know what you enjoyed about the conversation, what you took away, and what was helpful. Thank you, Claudine. You’re the best. Thank you so much.
You’re the best. Thank you so much.
Big thanks to the Théa team and Théa Pharma for supporting The 20/20 Podcast, for supporting us in our clinics, and for supporting the profession. One more big cheer from the Théa team. Awesome. Thank you again for tuning in to The 20/20 Podcast, Canada’s number one optometry podcast. We’ll see you guys in the next episode.
Important Links
- Harbir Sian on LinkedIn
- Claudine Courey on LinkedIn
- Harbir Sian on Instagram
- Théa Pharma Canada
- Eye Drop Shop
- Eye Drop Shop on Instagram
- Eye Drop Shop on TikTok
- Entrepreneurship in Eyecare with Dr. Claudine Courey
About Dr. Claudine Courey
Claudine Courey is an optometrist who graduated from University of Montreal school of optometry. She went on to pursue her residency is Corneal Disease & Contact lens and then furthered her studies by completing a Masters in Clinical Science. She is board certified in Canada and the USA and obtained her fellowship of the American academy of optometry as well as fellow of the Scleral lens society.
Dr. Courey practices in private practice as well as the specialty dry eye clinic at Bellevue Ophthalmology, an OD/MD practice.
In 2018, Dr. Courey identified a need to provide easy access to the highest quality eyecare products across Canada and this is when Eye Drop Shop was born. Eye Drop Shop has grown to be the leading dry eye resource in Canada, collaborating with industry as well as optometrists across the country. In 2020, Eye Drop Shop expanded into the USA and continues to grow and expand collaborations.
Dr. Courey is passionate to help her patients feel better every day in her clinical practice as well as through her reach with Eye Drop Shop.
